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SASTM NEWSFLASH

MERS-COV - EASTERN MEDITERRANEAN:

UNITED ARAB EMIRATES, WHO, SAUDI HAJJ

RECOMMENDATIONS

The Ministry of Health (MoH) in the United Arab Emirates (UAE) has notified WHO of a laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) in the country. The patient is an 82-year-old man with underlying medical conditions and is currently in critical condition.

Globally, from September 2012 to date, WHO has been informed of a total of 82 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.

Specimens from patients' lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised.

Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure so that further transmission of the virus can be prevented.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

WHO has convened an Emergency Committee under the International Health Regulations (IHR) on a precautionary basis in order to be prepared for a change in the situation. The Emergency Committee, which comprises international experts from all WHO Regions, will provide expert technical advice to the WHO Director-General in accordance to the IHR (2005). The 1st meeting of the Committee took place on [9 Jul 2013], and a further meeting is scheduled for next week [16 Jul 2013].

Saudi Arabia, Hajj recommendations

Saudi Arabia on Saturday [13 Jul 2013] urged elderly and chronically ill Muslims not to perform the Hajj pilgrimage, a measure to curb the spread of the MERS coronavirus, which has killed 38 in the kingdom.

The health ministry issued a set of conditions for people wanting to perform the annual Hajj, which this year falls in October [2013], or the year-round Umrah or minor pilgrimage.

They recommend postponing the Umrah and Hajj this year [2013] "for the elderly and those suffering chronic illnesses, like heart, kidney, respiratory diseases, and diabetes." People with immunity deficiency, as well as children and pregnant women, are also listed, according to a ministry statement posted on its website.

The statement did not set an age limit, and it was not clear whether the recommendation implies that no visas will be issued for such pilgrims.

The ministry said that the conditions were part of "preventive measures special to the MERS coronavirus." The kingdom is battling to contain the spread of the SARS-like coronavirus, which has infected 65 people in Saudi Arabia and led to 38 fatalities.

Those figures represent the majority of people affected worldwide -- 81 cases of infection and 45 deaths -- according to the World Health Organisation. The Saudi decision comes after the WHO convened emergency talks on MERS last week, with concerns expressed about its potential impact on the Hajj, when millions of Muslims head to and from Saudi Arabia.

Experts are struggling to understand MERS, or Middle East Respiratory Syndrome. The WHO has not recommended any MERS-related travel restrictions, but says countries should monitor unusual respiratory infection patterns.

The 1st recorded MERS death was in June last year [2012] in Saudi Arabia. Like SARS, MERS appears to cause a lung infection, with patients suffering from fever, coughing and breathing difficulties. But it differs in that it also causes rapid kidney failure.

Communicated by: ProMED-mail

An excerpted/edited version of the statement follows:

"The Ministry of Health issued health requirements that must be met in coming for Umrah and Hajj 1434 H [2013] as part of precautionary measures against the new coronavirus (MERS-COV) out of the keenness of the Government of the Custodian of the Two Holy Mosques in maintaining the health of everyone and providing a healthy and safe atmosphere for the pilgrims and for pilgrims to perform all rites smoothly and in good health and contentment.

"Included in these requirements issued by the ministry is the recommendation to postpone the performance of Umrah and Hajj this year [2013] for the elderly and people with chronic diseases such as patients with heart, kidney, respiratory and diabetes, as well as patients with congenital and acquired immune deficiency, in addition to those with tumors, as well as pregnant women and children.

"It also included requirements, tips, and guidance for health awareness for citizens, residents and pilgrims; all persons should wash their hands thoroughly with soap and water or disinfectant, especially after coughing and sneezing, and use tissue when coughing or sneezing; dispose of the used tissue in a waste basket; do not touch your eyes, nose, or mouth with your hands, reduce direct contact with ill individuals, and wear masks in crowded locations, maintaining personal hygiene as a whole.

"These requirements also included a valid certificate of vaccination against meningitis dated not less than 10 days and not more than 3 years before arriving at the Kingdom as well as a certificate of vaccination against polio if arriving from affected countries, according to specific requirements.

"They also included stipulations as to the importance of vaccination against seasonal flu, especially for people with chronic diseases such as heart and kidney disease, diabetes, and respiratory and neurological diseases, as well as HIV, congenital and acquired immunodeficiency, and metabolic diseases, as well as for pregnant women and children less than 5 years and those with obesity."

These recommendations are an expansion of the recommendation found on the Saudi Embassy website list of instructions for the upcoming pilgrimages.The recommendations are in keeping with the observation that the majority of severely ill (and fatal) cases had a history of the chronic comorbidities listed in the recommended groups to refrain from making the pilgrimage this year (2013).

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The content and opinions are neither pre-screened nor endorsed by the SASTM. The content should neither be interpreted nor quoted as inherently accurate or authoritative.

SASTM NEWSFLASH
The information provided in SASTM Newsflashes is collected from various news sources, health agencies and government agencies. Although the information is believed to be accurate, any express or implied warranty as to its suitability for any purpose is categorically disclaimed. In particular, this information should not be construed to serve as medical advice for any individual. The health information provided is general in nature, and may not be appropriate for all persons. Medical advice may vary because of individual differences in such factors as health risks, current medical conditions and treatment, allergies, pregnancy and breast feeding, etc. In addition, global health risks are constantly evolving and changing. International travelers should consult a qualified physician for medical advice prior to departure.

About SASTM

The SASTM’s Mission is to guide the profession in all aspects relating to the practice of travel medicine,
liaise with the travel industry, consult with relevant authorities,
advise the public and collaborate nationally and internationally on all aspects relating to Travel Medicine.

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